Capital Blue Enrollment/Change Form 

 

Professional - Spousal Health Insurance Premium - In accordance with the current BAEA Collective Bargaining Agreement, Article 26, Section C: “Employees who have a spouse that is eligible for group health insurance through the following employer categories: Federal, State and Local Governments, Institutes of High Education and other Educational Institutions (to include other school districts) are required to enroll the spouse in that employer’s plan. The employee may elect to maintain spousal coverage with the District by electing to pay an additional premium (to include the premium from section B and section C) to have the spouse remain on the District’s plan as follows.
These additional premiums shall begin July 1, 2016 and remain the same for the life of this contract. Employees are responsible for notifying the District if/when a spouse is eligible to receive health insurance benefits from one of the employer categories listed above.”

 

Capital Blue Medical Claim Form 

 

Capital Blue Vision Claim Form 

 

Capital Blue Dental Claim Form 

 

Capital Blue Coverage - Support - A summary of benefits for Medical, Dental and Vision for Support Staff.

 

Capital Blue Coverage - Professional - A summary of benefits for Medical, Dental and Vision for Professional Staff. 

 

Capital Blue Coverage - Admin - A summary of benefits for Medical, Dental and Vision for Administrative Staff. 

 

Group Life Insurance Beneficiary Change Form 

 

Prescription Mail Order Form 

 

Prescription Claim Form